Effects of Proton Center Closure on Pediatric Case Volume and Resident Education at an Academic Cancer Center

Publication date: Available online 8 November 2017
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): James Galle, David Long, Tim Lautenschlaeger, Richard Zellars, Gordon Watson, Susannah Ellsworth
PurposeChanges in radiation oncology infrastructure influence referral/practice patterns, which may affect resident educational experiences. This study aimed to analyze effects of closure of an academic proton treatment center (PTC) on pediatric case volume, distribution, and resident education.MethodsThis was a review of 412 consecutive pediatric (≤18 years) cases treated at a single institution from 2012-2016. Residents' Accreditation Council for Graduate Medical Education case logs for the same years were also analyzed. Characteristics of the patient population and resident case volumes before and after closure of the PTC are reported.ResultsOverall pediatric new starts declined by about 50%, from 35-70 per 6 months in 2012-2014 to 22-30 per 6 months in 2015-2016. CNS case volume declined sharply, from 121 patients treated in 2012-2015 to 18 patients in 2015-2016. In 2012-2014, our institution treated 36, 24, and 17 patients for medulloblastoma/intracranial PNET, ependymoma, and low grade glioma (LGG), respectively, compared to 0, 1, and 1 patients in 2015-2016. 49 patients were treated with craniospinal radiation (CSI) from 2012-2014, while only 2 patients underwent CSI between 2015-2016. Hematologic malignancy patient volume and use of total body irradiation remained relatively stable. Patients treated when the PTC was open were significantly younger (9.1 vs 10.7 years, p=0.010) and their radiation courses were longer (35.4 vs 20.9 days, p<0.0001) than those treated after its closure. Resident case logs showed only a small decline in total pediatric cases, as the percentage of pediatric cases covered by residents increased after PTC closure; however, residents logged fewer CNS cases after PTC closure vs. before.ConclusionsOverall pediatric case volume decreased following PTC closure, as did the number of patients treated for potentially curable CNS tumors. Our findings raise important questions regarding resident training in pediatric radiation oncology as these cases become increasingly concentrated at specialized centers.

Teaser

Changes in radiation oncology infrastructure influence referral/practice patterns and resident educational experiences. This study aimed to analyze effects of closure of an academic proton treatment center (PTC) on pediatric case volume, distribution, and resident education. We demonstrate a sharp decrease in overall pediatric cases and potentially curable CNS tumors treated at our center following PTC closure. Our findings raise important questions regarding resident training in pediatric radiation oncology as these cases become concentrated at specialized centers.


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